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Carotid stump pressure, stump pulse, and retrograde flow
D A DeLaurentis1, M J Dougherty, K D Calligaro
1Section of Vascular Surgery, Pennsylvania Hospital, Philadelphia.
American Journal of Surgery
|August 1, 1993
Summary
Measuring stump pressure, stump pulse, and retrograde internal carotid flow provides a comprehensive hemodynamic profile during carotid endarterectomy. These easily obtained metrics accurately reflect collateral blood flow, aiding in the prediction of hypoperfusion.
Area of Science:
- Neurology
- Vascular Surgery
- Anesthesiology
Background:
- Carotid endarterectomy requires monitoring hemodynamic status to prevent hypoperfusion.
- Predicting intraoperative hypoperfusion is crucial for patient outcomes.
Purpose of the Study:
- To evaluate stump pressure, stump pulse, and retrograde internal carotid flow for a comprehensive hemodynamic profile.
- To determine the predictive value of these hemodynamic measurements for hypoperfusion during carotid endarterectomy.
Main Methods:
- Measurements of stump pressure, stump pulse, and retrograde internal carotid flow were performed in 261 patients undergoing carotid endarterectomy.
- Statistical analysis was used to assess correlations between hemodynamic measurements and patient factors.
Main Results:
- Significant correlations were found between stump pressure, retrograde flow, and stump pulse (p < 0.001).
- Lower stump pressure, less retrograde flow, and absence of stump pulse correlated with contralateral carotid artery occlusion.
- No correlation was observed between the indication for surgery and hemodynamic measurements.
Conclusions:
- The triad of stump pulse, stump pressure, and retrograde flow reliably indicates collateral blood flow during carotid cross-clamping.
- These low-cost, easily performed measurements can guide selective shunting protocols.
- A protocol for selective shunting in patients under general anesthesia is proposed.